Comparison of computer-assigned Minnesota Codes with the visual standard method for new coronary heart disease events

The Minnesota Code is the most widely used electrocardiogram (ECG) classification system for epidemiologic studies and has been incorporated into several Computer algorithms. The authors compared the Modular ECG Analysis System (MC-MEANS) and NOVACODE computer ECG findings with the Visual coding standard for agreement and prognostic associations with coronary heart disease (CHD) events occurring during follow-up from 1987 to 1995 in 2,116 individuals participating in the Atherosclerosis Risk in Communities (ARIC) Study. The exact agreement between Visual and computer findings was greater than 90% for all Minnesota Code categories except Q-code, which was 77% for MC-MEANS and 81% for NOVACODE. Approximately 60% of all Q-codes were assigned by computer methods only. Among the 2,116 participants, there were 246 (11.6%) new coronary events. Unadjusted relative risks for codes assigned by the three methods were similar. When computer methods disagreed on code severity, the CHD occurrence rates for MC-MEANS-detected severer code versus NOVACODE-detected severer code were 21% and 7%, respectively. This study provides clear evidence that computers assign more and severer Minnesota Codes with similar prognostic importance as does the Visual method; it also alerts researchers to potential problems in pooling Minnesota Code data read by different methods.     

An expedited model for health care administration programs at the graduate level

In this paper, we report the development of a theoretical model for health care administration programs at the graduate level. Our model development was prompted by recently-expressed concerns that the training available to managers and executives in health care fields is encountering a number of problems: it is typically lengthy and expensive, and involves too many prerequisites. In terms of content, the training available may be too narrowly focused on performing functions, such as accounting, rather than managing the functions. We begin development by conducting a content analysis of several highly-regarded programs with commonly identified features. We next describe how those features can be incorporated into a fast-track, 33 hour program without prerequisites which is consistent with accreditation guidelines. Implications for executive education and research are discussed.     

A cost effectiveness analysis of stepped care treatment for bulimia nervosa

Background:

The cost effectiveness of various treatment strategies for bulimia nervosa (BN) is unknown.

Aims:

To examine the cost effectiveness of stepped care treatment for BN.

Method:

Randomized trial conducted at four clinical centers with intensive measurement of direct medical costs and repeated measurement of subject quality of life and family/significant other time involvement. Two hundred ninety‐three women who met DSM‐IV criteria for BN received stepped care treatment or cognitive behavioral therapy. Cost effectiveness ratios were compared.

Results:

The cost per abstinent subject was $12,146 for stepped care, and $20,317 for cognitive behavioral therapy. Quality of life ratings improved significantly with treatment, and family/significant other time burden diminished substantially.

Discussion:

In this trial, stepped care for BN appeared cost effective in comparison to cognitive behavioral therapy. Treatment was associated with improved quality of life and diminished time costs of illness. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013)     

多索茶碱及其片剂的高效液相色谱分析

多索茶碱及其片剂的高效液相色谱分析刘春胜，何秀峰，王云萍，谷士杰，周同惠（中国医学科学院、中国协和医科大学药物研究所，北京１０００５０）多索茶碱（ｄｏｘｏｆｙｌｌｉｎｅ）是用于治疗支气管哮喘合并支气管痉挛的慢性阻塞性肺部疾病的新一代黄嘌吟衍生物，其药...     

Executive development in healthcare during times of turbulence: top management perceptions and recommendations

In this research we report an analysis of comments from managers and executives in healthcare organizations to provide insights into the strategic management needs of healthcare organizations. The comments were obtained as part of a survey that asked upper-level managers and executives to identify strategic management skill and knowledge needs in healthcare organizations. After completing the survey, the respondents were given the opportunity to comment on any topics of concern to them. A total of 67 comments, many of them extensive and insightful, were obtained. In this paper, we review the literature dealing with educational and developmental needs of healthcare managers. Much of this literature is academic in nature and permits an interesting comparison to the perspective of management and executive practitioners. Emerging from the literature was a concern for environmental turbulence and a recognition that healthcare managers are at risk of falling behind in terms of skill development under such conditions. Respondent comments suggested a recognition of the potential problems. The comments are classified into four major categories: needs and skills in turbulent conditions; program and educational needs; issue clarification; and additional comments. Moreover, the first two categories appeared to break out into a set of six additional themes, which we suggest will be important to those designing programs for executive development in healthcare during turbulent times. While the source of this research is healthcare settings in Canada and the USA, the findings should be applicable to international healthcare organizations that use strategic management concepts and practices.     

The educational needs of healthcare managers and executives in the key strategic areas of healthcare

Management approaches used by many healthcare organizations lag behind those of similar competitive industries. The authors of this article report findings from an exploratory study of executives' perceptions of training needs in managerial strategy. The authors asked executives to rate the level of knowledge required for each of five key areas in strategic management and then to assess actual levels of knowledge in the field. They found that (a) strategic management is vital in this competitive industry, (b) there is a disconnect between what healthcare managers should know and what they actually know about the tasks of strategic management, and (c) more resources need to be devoted to strategic management training and the development of managers at all levels of healthcare organizations.     

Community education for cardiovascular disease prevention: risk factor changes in the Minnesota Heart Health Program.

OBJECTIVES. The Minnesota Heart Health Program is a 13-year research and demonstration project to reduce morbidity and mortality from coronary heart disease in whole communities. METHODS. Three pairs of communities were matched on size and type; each pair had one education site and one comparison site. After baseline surveys, a 5- to 6-year program of mass media, community organization, and direct education for risk reduction was begun in the education communities, whereas surveys continued in all sites. RESULTS. Many intervention components proved effective in targeted groups. However, against a background of strong secular trends of increasing health promotion and declining risk factors, the overall program effects were modest in size and duration and generally within chance levels. CONCLUSIONS. These findings suggest that even such an intense program may not be able to generate enough additional exposure to risk reduction messages and activities in a large enough fraction of the population to accelerate the remarkably favorable secular trends in health promotion activities and in most coronary heart disease risk factors present in the study communities.     

Synthesized MR images: comparison with acquired images

Synthesized and directly acquired spin-echo images were compared in order to assess the validity of magnetic resonance (MR) image synthesis as a method enabling retrospective formation of images by interactive manipulation of scan parameters. Synthetic images subjectively compared favorably in both accuracy and precision with acquired images when formed for the same values of echo (TE) and repetition times (TR) and for interpolated and extrapolated values of both TE and TR. Plots of synthetic and acquired signals within the same pixel sectors quantitatively showed comparable values for several regions of interest in the brain. Percent error and noise-normalized differences between acquired and synthetic images were tested as a quantitative measure of accuracy. Percent error was consistently less than 5% for brain parenchyma, and synthetic signals were accurate to within four times the noise level at acquisition. The apparent signal-to-noise ratio of synthetic images was comparable, superior, or inferior to similar acquired images, depending on the values of TE and TR. Total acquisition time required for synthetic formation of images for arbitrary values of TE and TR was equivalent to that of a single direct acquisition with a TR of 2,500 msec.     

Excretory urography with iohexol: evaluation in children

A multicenter clinical study was conducted using iohexol, a second-generation nonionic contrast medium, for excretory urography performed in 130 children. Doses of iohexol (300 mg iodine/ml) ranged between 150 and 660 mgI/kg (0.5 and 2.2 ml/kg). Iohexol was tolerated well, and no significant adverse reactions occurred. Sixty-five iohexol urograms were evaluated to determine the minimum dose for adequate visualization of the kidneys and collecting systems. A dose greater than 300 mgI/kg (1.0 ml/kg) always resulted in a urogram of diagnostic quality, while visualization was insufficient for diagnosis in 10% of studies done with doses of 150-300 mgI/kg (0.5-1.0 ml/kg). Another 65 iohexol urograms were compared in a blinded manner with a similar number of studies performed using iothalamate meglumine at comparable iodine concentration and dose. Visualization of calyces and pelvoinfundibular structures achieved with iohexol was rated better with statistical significance, but there was no difference in visualization of the renal parenchyma or ureters. Use of iohexol in excretory urography may be advantageous in children who are at greatest risk for an adverse reaction to contrast media or in those most likely to benefit from use of a low osmolality contrast agent.